{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARIA   J MIDDLEBROOKS","gend":1,"add":"MILDRED AND JAMES MIDDLEBROOKS","city":"LYNDHURST","state":"VA","zip":"22952-2602","dob":"1972-02-10","age":"","mstatus":"","insh":10033975,"cliId":"","pno":5409436832,"cno":5409436832,"email":"","ename":"","eno":"","pphy":"FARLEY, BENJAMIN GATES","ppno":5408866259,"pcpadd":"42 Lambert St, Ste 511","pcpcity":"Staunton","pcpstate":"VA","pcpzip":244012437,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"604 MT. TORREY ROAD","add3":"","madd1":"MILDRED AND JAMES MIDDLEBROOKS","madd2":"604 MT. TORREY ROAD","madd3":"","mcity":"LYNDHURST","mstate":"VA","mzip":"22952-2602","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J96.01","R65.20","J09.X1","L21.9","L81.9","L82.1","D23.71","L85.8","A41.9","J18.9","J13","J10.08","F84.0","N17.9","E87.2","G40.909","E87.6","R74.8","E66.9","R33.9","Z68.32","J10.1","J15.4","Z87.01","N64.89","G40.219","Z00.00","Z23","Z12.31","L30.9","R92.8"],"date":["2019-03-02","2019-03-02","2019-03-02","2020-11-20","2020-11-20","2020-11-20","2020-11-20","2020-11-20","2019-02-28","2019-02-26","2019-02-26","2019-02-26","2019-02-26","2019-02-26","2019-02-26","2020-12-02","2019-02-26","2019-02-26","2019-02-26","2019-02-26","2019-02-26","2019-02-28","2019-02-28","2019-06-10","2020-10-21","2020-12-02","2020-09-28","2020-09-28","2020-09-28","2020-09-28","2020-10-21"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","00131247935","VIMPAT ","TAB 150MG","120","Select","Select",""],["","45802049326","AMMONIUM ","CRE 0.12","385","Select","Select",""],["","65862053820","LEVOFLOXACIN ","TAB 750MG","2","Select","Select",""],["","00054001729","PREDNISONE ","TAB 10MG","10","Select","Select",""],["","70710101002","OSELTAMIVIR ","CAP 75MG","3","Select","Select",""],["","33342032815","TRIAMCINOLON ","CRE 0.005","15","Select","Select",""],["","45802046564","KETOCONAZOLE ","SHA 0.02","120","Select","Select",""],["","51672135708","FLUOCIN ","OIL 0.01% SC","118.28","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":""}]}]}